Mdi Sulcus Sign In Neutral

Name of the Test: Sulcus sign, Sulcus test, inferior humeral head translation test

Indications: To diagnose multidirectionaly instability of the glenohumeral joint.

How to perform the test: The patient is seated with arms relaxed by their side, forearms resting on the thighs with elbows flexed 60-90 degrees. Helmig et al (Clin Orthop 252: 139-142,1990) reported that maximal inferior excursion of the glenohumeral joint occurs in 20 degrees of abduction and slight internal rotation. The Examiner grasps the distal humerus with one hand and places the thumb and index finger just anterior and posterior to the acromion with the other. The examiner then applies an inferior force with hand holding the distal humerus fairly rapidly.

What constitutes a positive or negative test: A few grading systems are available. Mallon and Speer (JSES Jan-Feb;4(1 Pt 1):54-641995) recommended the following grading system: Grade I: less than 1 cm inferior translation; Grade II: 1.0-1.5 cm of inferior translation; and Grade III: greater than 1.5 cm of inferior translation

Reliability:
Inter-examiner: ICC=0.66 (Tzannes and Murrell, Sports Med, 32:447-57, 2002)

Validity:
Sensitivity:
72% if greater than 1 cm (Tzannes and Murrell, Sports Med, 32:447-57, 2002)
28% if greater than 2 cm (Tzannes and Murrell, Sports Med, 32:447-57, 2002)
Specificity
85% if greater than 1 cm (Tzannes and Murrell, Sports Med, 32:447-57, 2002)
97% if 2 or more cm (Tzannes and Murrell, Sports Med, 32:447-57, 2002)

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